Would You Know It If You Saw It?

Recently, according to a story published in MedPage Today, a diagnosis of measles was delayed in three American children who had returned from traveling abroad where they contracted the disease. Four of them ended up hospitalized for measles-related complications.

The article noted that measles “isn't often considered in the initial differential diagnosis of children returning from international travel with a rash illness." That’s because measles was officially declared eliminated in the U.S. in 2000.

So those docs who examined the children may never have seen an actual case before.

Who would have thought it? Measles – every kid used to get that. Sore throat, fever, and rash –- measles was probably the first thing that came to a parent’s mind. It traveled through the neighborhood each year, searching for any victims it may have missed in the previous go-round.

One of the nice things about being a little older is that you can see wonders like this coming together over time. I can remember a day about 30 years ago, when I had a sneak preview of a world where one day measles could be conquered.

The MMR vaccine was licensed in 1971 and my son, Joe, born in 1974, received his shot in 1975.

But in 1982 I found myself sitting in the pediatrician’s exam room with my 7-year-old son slumped in my arms – lethargic, feverish, with a rash.

But he had had his vaccination six years before, so the last thing I expected was . . .

Diagnosis: Measles.

Unlike the doctors of today who missed the mark, it didn’t take an old hand like Dr. Laub long to recognize what he was dealing with. It was measles, all right.

It caused quite a stir in the office. The doctor immediately called in his younger associates, so they could actually see what a case of live measles looked like. I recall him shining his flashlight into the back of Joe’s throat and pointing out the clues he saw there.

Afterwards, the nurse and receptionist ushered us out the back door lest Joe infect other children in the waiting room (or at least any more of them). Dr. Laub must have reported us to the CDC, because later I got a call from Atlanta inquiring where we had been to contract the disease.

Nowhere special – the mall, the supermarket. I had nothing to tell them. Nobody else we knew had measles.

But why did my son get measles if he had been vaccinated?

The way it was explained to me at the time was that in the early days of the measles vaccination campaign, the guidelines recommended vaccinating babies too early – before their immune system was able to do whatever it needs to do to sustain the immunity.

But I later learned that a small number of persons failed to develop immunity after one dose, so a second dose was introduced in 1989. So perhaps Joe was one of those.

At any rate, Joe must have been one of the last to earn his immunity to measles the old-fashioned way. He was sick for about 10 days and then, fortunately, recovered completely.

But what I remember best about the whole incident was the older doctor’s reaction – the look in his eye as he gathered the younger men around him and examined my son. He was excited, intense, pointing out this sign and that symptom and pouring out the many insights into this disease that he had gained over the years.

It was as if he had seen an old enemy again – one that he had faced many times in the past. Only this time, he had recognized -- through the rarity of the encounter -- that it would soon be over, and that the battle had, in fact, been won.

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